# Cancer-associated thrombosis prevention and treatment

Source: https://onco.cc/technologies/cancer-associated-thrombosis/  
OnCo record `cancer-associated-thrombosis` (Technology). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Blood clots are the second commonest cause of death in people with cancer. Risk scores identify who should take preventive blood thinners during chemotherapy, and direct oral anticoagulants have largely replaced injections for treatment.

## Summary

Cancer raises venous thromboembolism risk 4-7-fold (highest in pancreatic, gastric, brain, lung cancers and myeloma on IMiDs). The Khorana score (2008) identifies high-risk outpatients; AVERT (apixaban) and CASSINI (rivaroxaban) trials (2019) showed primary thromboprophylaxis roughly halves VTE in Khorana ≥2 patients with acceptable bleeding, now recommended by ASCO/ITAC/NCCN. Treatment: LMWH was standard after CLOT (2003); Hokusai VTE Cancer (edoxaban), SELECT-D (rivaroxaban), Caravaggio (apixaban) established DOACs, with LMWH preferred for luminal GI tumours (bleeding) and drug interactions. Duration ≥6 months while cancer active. Central venous catheter thrombosis, arterial events with VEGF inhibitors and BTK inhibitors, and incidental PE are common management problems. Anticoagulation in brain tumours and thrombocytopenia requires individualisation.

## Fields

- Kind: Technology
- Status: standard-of-care
- Last checked: 2026-09-08
- Tags: gap-fill; supportive
- Principle: Stratify VTE risk (tumour type, chemotherapy, biomarkers) to target prophylaxis; treat established thrombosis with anticoagulation weighed against tumour-specific bleeding risk.
- Strengths: Validated risk score and two positive prophylaxis RCTs; Oral DOACs simplify treatment; Guidelines aligned across ASCO, ESMO, ITAC
- Limitations: Bleeding in GI and GU tumours and with thrombocytopenia; Prophylaxis uptake remains low; Arterial thrombosis less studied

## Notes

- NICE NG85 points to its venous thromboembolism guideline for people with pancreatic cancer; Pancreatic Cancer UK says injections of blood-thinning medicine continue for about four weeks after surgery and that a nurse shows you how to give them.

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Trousseau_sign_of_malignancy
- ASCO VTE guideline update 2023: https://doi.org/10.1200/JCO.23.00294
- Khorana score (Blood 2008): https://doi.org/10.1182/blood-2007-10-116327
- Pancreatic Cancer UK: blood clots in a vein and pancreatic cancer: https://www.pancreaticcancer.org.uk/information-and-support/managing-symptoms-and-side-effects/blood-clots-in-a-vein-dvt-and-pancreatic-cancer/
- NICE NG85: pancreatic cancer in adults, diagnosis and management, recommendations: https://www.nice.org.uk/guidance/ng85/chapter/Recommendations

## Connected records

- cancers: [Gastric & gastro-oesophageal junction cancer](https://onco.cc/cancers/gastric/), [Glioma & glioblastoma](https://onco.cc/cancers/glioblastoma/), [Multiple myeloma](https://onco.cc/cancers/multiple-myeloma/), [Non-small-cell lung cancer](https://onco.cc/cancers/nsclc/), [Pancreatic ductal adenocarcinoma](https://onco.cc/cancers/pancreatic/)
- fronts: [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- technologies: [Anti-angiogenic therapy](https://onco.cc/technologies/antiangiogenic/), [Cytotoxic chemotherapy](https://onco.cc/technologies/cytotoxic-chemotherapy/)
- companies: [Rovi](https://onco.cc/companies/rovi/)
- key papers: [Development and validation of a predictive model for chemotherapy-associated thrombosis](https://onco.cc/key-papers/paper-khorana-blood/), [Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer: ASCO Guideline Update](https://onco.cc/key-papers/paper-key-j-clin-oncol/)
- terms: [Palliation in pancreatic cancer: biliary and duodenal stents, coeliac plexus block, enzymes and cachexia](https://onco.cc/terms/pancreatic-palliation-obstruction-pain-nutrition/), [Venous thromboembolism (VTE)](https://onco.cc/terms/vte/)
- pathways: [Intravasation & circulating tumour cells](https://onco.cc/pathways/intravasation-ctc-survival/)
- roadmaps: [Supportive care and survivorship roadmap: making treatment bearable → proving it extends life → caring for tens of millions afterwards](https://onco.cc/roadmaps/survivorship-roadmap/)

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